Nigeria is on the path towards controlling HIV —NACA DG Gambo Aliyu

HIS appointment is widely acclaimed as a round peg in a round hole. Reasons for this are not farfetched. Before President Muhammadu Buhari appointed him as director general of the National Agency for the Control of AIDS (NACA) in July, Dr. Gambo Gumel Aliyu has been deeply involved in the research and management of HIV for almost two decades. An alumnus of Ahmadu Bello University where he bagged an MBBS in 1995, Dr. Aliyu obtained a Masters in Clinical Research and PhD in Epidemiological Research (HIV and TB) from the University of Maryland, United States, in 2008 and 2012, respectively. Until his appointment, the new DG was the Chief of Party for the Nigeria Indicator and Impact Survey (NAIIS), touted as the world’s largest HIV population-based survey, which helped Nigeria to assess the true impact of HIV services delivered in the last 15 years of the US President’s Emergency Plan for AIDS Relief PEPFAR. His journey to his new job started in 2002/2003 when he was trained in the US to develop centres of excellence for HIV treatment and prevention of mother to child transmission of HIV in Nigeria, ultimately ending up as one of the 20 Nigerian scientists specifically trained to prepare the American government ready for the PEPFAR. An epidemiologist and public health specialist from Jigawa State, Dr. Aliyu served as Country Director for the University of Maryland programmes in Nigeria and did his post-doctoral fellowship at the University of Manitoba, Canada, where he studied drugs and vaccines evaluations. He took over the headship of the agency in July from Dr. Sani Aliyu (from Kano State) who resigned his appointment to pursue other aspirations a year before the end of his four-year tenure. The 50-year-old NACA DG spoke with Associate Editor ADEKUNLE YUSUF. Excerpts:-

THE whole world commended Nigeria over NAISS report, which showed that significant success has been recorded in the control of HIV in the country. What is the next step after NAIIS?

First and foremost, NAIIS report was meant to inform the Nigerian government and the world, especially the donor agencies, about the impact of 15 years of investment since PEPFAR came on board. We found the programme to be very impactful; those things that have been in place in the last 15 years have worked to achieve the desired results. It has helped in controlling the epidemic to a great extent. We are yet to control it completely, but if I am to put it on a scale of zero to 10 in terms of where we have been controlling the HIV epidemic in Nigeria, I will tell you we have got six over 10. If you want to understand the impact and if you look back to the time when PEPFAR came on board with a lot of investments in HIV prevention, treatment and logistics, the prevalence was very high. After the NAIIS evaluation, we found out that the prevalence was about 1.4 per cent from 4.4 per cent, down by 3 per cent points. What that means is that back in 2005, when the PEPFAR programme began, if you take Nigerians and put them in one room and you close your eyes and pick 200 people at random to undergo HIV test, you are likely to find nine out of 200 that would test positive. That was then. But with the report of NAIIS, with a prevalence of 1.4 per cent, if you repeat the same thing you did in 2005 in 2018 by selecting 200 Nigerians at random from a room to undergo HIV test, only three bof them are likely to test positive to HIV. That is how impactful the programme has been in reducing HIV transmission and spread among people. This massive feat was achieved because of the combination of prevention and treatment and awareness, sensitisation and literacy on HIV transmission and prevention. What the treatment does is to clear this virus from the blood; to make the virus disappear so that when you look for sometime you don’t see it. The impact of that is that it denies the HIV the opportunity to destroy somebody’s immune system or progress from what it is to what we call AIDS. On the other side, it also prevents HIV from leaving one person to enter into another person’s body because it is not there in the blood again or the number has been significantly reduced that there is no virus to transmit , since infection is usually a factor of the volume of virus.

Because of that, we have seen a drastic reduction in new HIV infections and people dying from HIV; it has reduced drastically. And it is so because of the drugs that have been supplied for 15 years without any disruption. Going forward, we will ensure that these drugs continue to flow without disruption; if we want to totally control HIV, we must make sure these drugs are available for patients and ensure they are taking the drugs. For whatever reason, if the drugs are not available and accessible or that people don’t take the drugs, people will be at the risk of transmitting the virus. Secondly, we must have a very robust system that enables us as a nation to have a robust data of people living with HIV in Nigeria.

The good thing about this is that if we have had a robust data system in the past, surveys like NAIIS and the amount of money that was sunk to do it will not have arisen. It is because we don’t have a data that we can reliably say we believe in and it is, to a large extent, representative of the Nigerian population and that what we get from the data is the exact thing we are looking for. Then, I will not need survey to do this for me. For example, if you compare with countries like the US, Canada and the United Kingdom, you probably will not hear of HIV survey there simply because they have data on everyone that goes to hospital and undergoes HIV testing and his or her result is recorded somewhere and government has access to it. If there is data, I only need to click on the system to know how many people have been tested in Nigeria or how many people have accessed treatment in this country. And in terms of how many of those tested positive, it will also be a matter of clicking on a button.

The key thing is that if you can achieve three things, if you can get 90 per cent of people in society to undergo HIV test and get 90 per cent of those who know they have HIV to access treatment and get 90 per cent of those on treatment to take the treatment seriously and make sure it works very well in suppressing the virus in the blood. Once that is achieved, you are tending to what we call control of the epidemic. What happens after you control the epidemic is that you will be required to sustain it. And sustainability means you no have longer new cases of HIV or very few transmissions are taking place or very few people are dying because they are getting good treatment. But you still have one issue to deal with. That is, these guys that are taking the drugs must continue to take the drugs and continue to have their blood tested for the virus to see whether the virus is under check. So that will be the challenge for Nigeria because the funding we are getting from international donors will not be there forever. There is a level upon which the funders begin to divert resources where the epidemic has not been controlled. Since your own has been controlled, they will want you to take the responsibility and taking that responsibility is where the issue lies.

My goal in the next four years is to make sure that that sustainability path is created and actualised. And for this, we are looking at bringing in the private sector to participate in supporting HIV services in Nigeria.

(Cuts in) Why the private sector?

The private sector has a lot to contribute and has a lot to offer. And they are willing to contribute to help the government to control HIV; to help and partner with the government to sustain HIV control in Nigeria. Right now, we are partnering with the private sector to see how that is actualised before the end of the year. We want to launch what we call the ($150 million) HIV trust fund this year. Nigeria has done very well in trying to get HIV under control; it is not controlled yet, but we are on that path. Indeed the intervention that has been put in place in the last 15 years has worked very well. And the governors have also promised to dedicate 0.5 per cent of their allocation to fight HIV in their states so that we can have sufficient resources to continue with our HIV prevention and control services, including advocacy awareness, supply of test kits and strengthening treatment services to make sure that there are no gaps.

Nigeria will eventually come forward to take ownership. That time is approaching because we are headed towards controlling the epidemic. Once the epidemic is controlled or as the epidemic shrinks, the money that foreign donors give to support the (fight against the) epidemic also shrinks. The goal is to sustain the services even after the donors have left. We will reach a time when Nigeria will be providing for 37 out of 37 states, instead of two out of 37 states. We want to have the mechanism in place to ensure that resources are available for continuity. Let me add that the donor agencies have not indicated that they will leave us before we have the epidemic under check, but everything has a lifetime. As we have gradual disengagement of donor agencies, we can have gradual takeover that will look seamless; without any disruption. We want to make sure we have enough structures in place to continue to provide the needed services for people living with HIV in Nigeria – for testing and protection.

What is the response like from the private sector?

The response has been very encouraging. I just flew in from Abuja to have a meeting with the Group Managing Director of Access Bank in Lagos. What will interest you is that he was sick but he created time to come to the office to have a meeting with me. While we were having the meeting, he was in pain; you could see it visibly in him that he really needed to rest, but he denied himself to show his commitment. This really encouraged me. This means he has this thing in his heart and that he is interested in making this a reality.